Konno N
Nihon Naibunpi Gakkai Zasshi. 1976 Feb 20;52(2):158-68. doi: 10.1507/endocrine1927.52.2_158.
The interval between the onsets of the QRS complex and of the brachial Korotokoff sounds at the diastolic pressure was termed QKd and it was already known that QKd was shortend in hyperthyroidism and prolongad in hypothyroidism distinctly. In the present study, simultaneous measurements of QKd, serum thyroxine (T4) and triiodothyronine (T3) concentrations, free T4 index (FT4I) and free T3 index (FT3I) were undertaken and attempts were made to examine the possible correlation of QKd to these parameters of thyroid function in sera. The QKd values of 24 euthyroid subjects had a normal range of 190 to 230 msec., 10 patients with hypertyroidism had Qkd values ranging from 145 to 180 msec. and 9 hypothyroid patients had QKd values ranging from 230 to 305 msec. Plots of QKd agaist serum T4 and T3 concentrations denoted statistically significant inverse relations in the T4 and T3 concentrations denoted statistically significant inverse relation in the T4 and T3 concentrations approximately less than 20 mug/dl and 400 ng/dl respectively (4 = 0.59 and -0.62 respectively) and above these concentrations of T4 and T3, QKd was nearly constant at the level of 165 msec irrepective of T4 and T3 concentrations. The statistically significant inverse relations were also observed between QKd and FT4I and FT3I in the FT4I and FT3I values less than 18 and 280 respectively (r= -0.80 and -0.74 respectively) and above these values of FT4I and FT3I, QKd was remained constant. In 18 hyperthyroid subjects receiving antithyroid medication, QKd, FT4I and FT3I were measured. QKd values from the patients whose FT4I and/or FT3I were above normal were significantly shorter than the QKd from the patients with normal FT4I and ft3i (183 +/- 9.8 msec vs 211 +/- 19 msec, p less than 0.01). In 16 patients with primary hypothyroidism receiving L-thyroxine for replacement therapy more than 6 months of period, QKd, FT4I and FT3I were measured and TRH-test was performed. FT4I and FT3I in these patients were all in normal range and 8 out of 16 patients had normal response to TRH-test and others were of no response to TRH-test. No difference in QKd values was obtained between patients with normal response and with no response to TRH-Test. These results indicate that QKd is more closely related to serum free T4 and free T3 concentrations and the extent of prolongation of QKd in hypothyroidism reflects the decreased serum thyroid hormone concentrations, whereas the shortend QKd in hyperthyroidism does not parallel the increased serum thyroid hormone concentrations. QKd is useful index not only for the rapid assessment of thyroid function as proposed by previous investigaters, but also for the rpaid evaluation of efficacy of antithyroid drugs administered in hyperthyroidism.
QRS波群起始与舒张压时肱动脉柯氏音起始之间的间期称为QKd，已知甲状腺功能亢进时QKd缩短，甲状腺功能减退时QKd明显延长。在本研究中，同时测量了QKd、血清甲状腺素（T4）和三碘甲状腺原氨酸（T3）浓度、游离T4指数（FT4I）和游离T3指数（FT3I），并试图研究QKd与血清中这些甲状腺功能参数之间可能的相关性。24例甲状腺功能正常的受试者QKd值正常范围为190至230毫秒，10例甲状腺功能亢进患者的QKd值为145至180毫秒，9例甲状腺功能减退患者的QKd值为230至305毫秒。QKd与血清T4和T3浓度的关系图显示，在T4和T3浓度分别约低于20μg/dl和400ng/dl时，存在统计学上显著的负相关（相关系数分别为-0.59和-0.62），而在T4和T3浓度高于此值时，无论T4和T3浓度如何，QKd几乎恒定在165毫秒水平。在FT4I和FT3I值分别小于18和280时，QKd与FT4I和FT3I之间也观察到统计学上显著的负相关（相关系数分别为-0.80和-0.74），而在FT4I和FT3I高于这些值时，QKd保持恒定。在18例接受抗甲状腺药物治疗的甲状腺功能亢进患者中，测量了QKd、FT4I和FT3I。FT4I和/或FT3I高于正常的患者的QKd值显著短于FT4I和FT3I正常的患者的QKd值（183±9.8毫秒对211±19毫秒，p<0.01）。在16例接受L-甲状腺素替代治疗超过6个月的原发性甲状腺功能减退患者中，测量了QKd、FT4I和FT3I，并进行了促甲状腺激素释放激素（TRH）试验。这些患者的FT4I和FT3I均在正常范围内，16例患者中有8例对TRH试验有正常反应，其他患者对TRH试验无反应。对TRH试验有正常反应和无反应的患者之间QKd值无差异。这些结果表明，QKd与血清游离T4和游离T3浓度关系更密切，甲状腺功能减退时QKd延长的程度反映了血清甲状腺激素浓度降低，而甲状腺功能亢进时QKd缩短与血清甲状腺激素浓度升高不平行。QKd不仅是先前研究者提出的快速评估甲状腺功能的有用指标，也是快速评估甲状腺功能亢进患者抗甲状腺药物疗效的有用指标。
